Case Report: Paracoccidioidomycosis in Solid Organ Transplantation: Disseminated Disease in a Liver Recipient and Literature Review

Abstract

Paracoccidioidomycosis (PCM) is an endemic systemic mycosis that is of great importance in Latin America. Its occurrence in solid organ transplantation (SOT) is rare, but with high mortality rate. In this report, we describe a case of PCM in a liver transplant recipient 19 months after transplantation. The patient presented with multiple skin abscesses, arthritis, osteolytic lesions, and pulmonary and adrenal involvement. Despite the presence of disseminated disease and the patient's immunosuppressed condition, the patient responded well to prolonged antifungal treatment with no sequelae, thus suggesting that early diagnosis and correct treatment may lead to favorable outcomes in SOT recipients with PCM.

New Insights on Pulmonary Paracoccidioidomycosis

“…35,[48][49][50] There are only 11 cases reported in solid organ transplantation, but as organ transplantation becomes more available in endemic areas of PCM, awareness of PCM pre-and posttransplant is important, as is investigation of PCM in cases of chronic granulomatous disease. [51][52][53][54][55][56][57][58] In the same way, the use of immunobiological therapy has been growing, and cases of PCM during its use have been reported. 59,60 Case series and isolated case reports suggest that cancer occurs in 0.6 to 11% of patients with PCM, mainly carcinomas of the respiratory and digestive tract, which share the same risk factors as PCM, that is, smoking and alcoholism.…”

Paracoccidioidomycosis 40 years after renal transplantation: a case-report

“…Although the prevalence is higher in kidney transplantations, liver and lung receivers are at higher risk 2,4,5 . A Brazilian study collected 102 autopsy samples from renal transplants and found the PMC in four individuals, being the described cause of death in one of them 6 .…”

“…Paracoccidioidomycosis (PMC) is a systemic fungal disease prevalent in Latin America, with the majority of cases found in Brazil 1,2 . It is caused by thermally dimorphic fungi from Paracoccidioides brasiliensis (P. brasiliensis) and Paracoccidioides lutzii (P. lutzii) complexes, with the last one being described in Brazil's North and Midwest regions.…”

“…Although the condition is considered rare in solid organ transplants (SOT), the disease's severity potential is high, considering high mortality rates in this situation 2 .…”

“…Besides the difficulty in diagnosing paracoccidioidomycosis, the small number of cases reported in immunosuppressed, reinforces the challenge of early diagnosis [2][3] .…”